2 sorso4 612 oss 000 ‘is Juin or Nemes ax MestaL esas Cope ©1968 Vol 18, No.2 Printed in US Commentary On “Human Pharmacology of Hoasca”’ A Medical Anthropology Perspective MARLENE DOBKIN pe RIOS, Pu.D.! As Strassman (1995) pointed out in this Journal, clinical research with hallucinogens has resumed af- ter a generation's hiatus. Strassman argues that “hu- man hallucinogen research will help define unique mind-brain interfaces, and provide mechanistic hy- potheses and treatment options for psychiatric dis- orders,” and that state of the art methodologies need to be incorporated into such studies (p. 127), It is particularly interesting that this hiatus in hal- lucinogenic research with human subjects has ex- isted despite the fact that between 13 and 17 million individuals in this country alone have used a hall cinogen at least once (National Institute of Drug Abuse, 1991). It behooves transcultural psychiatric researchers to examine the social contexts in which. such substances have a history of use and to apply rigorous scientific methodologies to study them, es- pecially in understanding natural laboratories in which these plants have been utilized to treat psy- chiatric disorders, In doing this, and in an exemplary fashion, Grob et al. have turned to the Uniao do Vegetal (UDV), a syneretic religious group in Brazil, where one plant hallucinogen, hoasca (also known as. ayahuasca), comprising harmine, harmaline, and tetrahydrohar- maline, is used in bimonthly ritual ceremonies. To- day there are more than 5000 adherents of this religious group in over 60 centers throughout Brazil, inspired by traditions of drug use from the Peruvian Amazon (Gallant, 1995). Moreover, hoasea use is of- ficially recognized by the Brazilian government for use in 22 religious sects in that country. Unlike the larger Brazilian sect, Sainto Daime, with its over- tones of drug tourism, the UDV does not proselytize "Department of Psychiatry and fuman Behavior, University ‘of California, irvine, Mail RU 181, University of California Irvine ‘Medical Center, 101 City Drive South, Orange, California 02068, Drug tourise is a phenomenon in recent years where West emers exploit id World drug rituals that are promoted to Wi y seek to experience mystical states on demand, usually paying high fees to do so, This occurs ‘outside the sociocultural Context of use (see Dobkin de Rios, 1904), 95 foreigners. Adherents are given the plant tea (150 ml of the drink) at each setting twice a month. In this brief Commentary, I will draw upon my: work as a medical anthropologist and psychothera- pist who has studied ayahuasca use among urban populations in the Peruvian Amazon cities of Iquitos and Pucallpa for the last 25 years so as to provide a social context for the hoasca use. The Peruvian data focused on the psychological effects, out- comes, and therapies used by Peruvian mestizo* ‘men and women healers in contemporary ayahuasca treatment of patients’ emotional and psychiatric problems. It is also important to understand the rise of new religions in Brazil, such as the UD, which emanate not from a native American tradition (de- spite the rhetoric of the search for “indigenous wis dom" to legitimize the hoasca use) but rather as a social movement, one of numerous batuque! sects, ‘These arose in response to fast-paced social change in Brazil (see below). Major influences can be traced from Europe and North America in the context of spiritist and spiritualist churches that promise med- iumistic contact with the dead and altered states of consciousness as a means of contact with spirit forces. Many, too, have been linked historically to African religious survivals in the wake of 400 years of black slavery. The UDV, in particular, is repre- sentative of spiritist religions with nontraditional Christian theological constructs, merged with a 19th century faith in the union of science and religion. The term mestizo refers to individuals whose ethnic heritage derives from indigenous and European miscexenation, “The term is-a generic one in which Afro-Brazilian cultures have reached Belem and other Amazon cities, similar to that of Candomble of Bahia, Xango of Recife, and the terreirs of Mar nao. These cults underwent profound changes as they alapted {othe Amazonian environment and range from Yoruban-Dahorn- evan (GegeNago) cults to others more heavily influenced by European spiritism (Leacock and Leacoek 1972). Batu is com ‘cerned primarily with everyday problems and not eschatological beliefs, and according to Moran (1974), “its remarkable growth in recent years indicates its success in helping the urban poor ope with the stresses of madem life in the urban scene” (p 15),96 DOBKIN DE RIOS Comparison of Peruvian Mestizo Ayahuasea Use with Brazilian UDV Use In both the Peruvian and Brazilian Amazon, mes- tizo men and women who use the plant hallucinogen in a ritual context of healing turn to the autochtho- nous peoples of the region and their historical use of the substance to legitimize and valorize contem- porary use. This is particularly common since the 1960s, with the growing European and American in- terest in native mysticism. Thus, numerous aya- huasca healers whom I interviewed in the 1960s and 1970s, spoke about their personal experi among Indian peoples and. partici huasca sessions. The most famous of this genre is Cordova-Rios's work (Lamb and Cordova-Rios, 1971). The Brazilian rubber bonanza of the late 19th century is one in which many native peoples were forced into rubber gathering activities and aya- huasea use became more generally known by Bra- zilian nationals In my summary of historical data in Visionary Vine (Dobkin de Rios, 1972), I wrote that contem- porary ayahuasca use in the Peruvian Amazon is found in the context of healing rituals that utilize the plant hallucinogen to identify the individual be- lieved responsible for a witchcraft hex that is said to cause the client's physical or psychiatrie disorder. In the traditional hunting/gathering societies or the incipient horticultural societies of the Colombian, Peruvian, Ecuadorian, and Brazilian Amazon, such as the one studied by Siskind (1972), hallucinogenic use functioned in the context of shamanism. Plants were used to contact and control rain forest spirit forces for political, social, and economic motives, and hallucinogenic healing was only one of many shamanic functions. Gow (1994), in a provocative article on shamanism and history in Western Amazonia, argues convineingly that the contemporary ayahuasca use we see among, mestizos in the Westem Amazon is not part of an un- broken pre-Columbian cultural tradition. Rather, it is ‘a phenomenon that has been evolving in urban con- texts over the past 300 years, which has been ex ported from towns such as Pucallpa and Iquitos, Peru, to isolated tribal peoples to become the dominant form of shamanic curing practice in the region. Ac- cording to Gow (1994), ayahausca healing evolved as. a response to the specific colonial history of Western ‘Amazonia and the spread of the rubber industry in the region. Gow argues that the ayahuasca curing ritual originated in the specific milieu of early Jesuit and Franciscan missions of the region, and the massive disruption caused by epidemic illness to numerous in- digenous populations. It expanded in the Amazon when the mission system was transformed by the rubber boom in the late 19th century. ‘The typical tribal shamanic healer is trained in the diagnosis and curing of illness with the hallucinogen ayahuasea. A younger shaman, generally male, trains for many years with an elder, taking the plant per- sonally and learning curing songs. It is generally be- lieved that the shaman can magically suck out sor- cery objects that are introjected by a witch or evildoer which cause certain culture-specitfic ill- nesses. A majority of illnesses are believed to be caused by the revenge of natural species on people who use theru, The evil of people can afflict healthy adults by means of sorcery when an individual mag ically introjects a chonta (thorn) into the victim's body. The healer uses the plant hallucinogen for its revelatory properties to allow him to diagnose and then cure the patient. There is a pantheon of super- natural agents of river and forest which are called upon by the healer to return the evil to its perpetr tor and to provide visions of healing plants to give to the patient. From a psychiatric perspective on transference phenomena, healers are believed to be omnipotent and all-knowing and are expected to protect their community from evil. When we turn to the urban mestizo healer who uses ayahausca in cities like Iquitos and Pucallpa, we find that healers typically diagnose illness either as natural or supernatural in origin. Such healers are very effective in treating a wide variety of somatized illnesses due to the numerous stressors experienced by urban peoples in a fast-changing world for which they often have little preparation, given the move- ment of rural, illiterate peoples from countryside to city. Urban Third World poverty and malnutrition compound these stressors and healers are often called upon to deal with interpersonal conflicts, di- vorce and separation of spouses, and issues of envy and anger. A culture-specific psychiatric syndrome, saladera (Dobkin de Rios, 1981), has been de- scribed, linked to personal misfortune which char- acterizes the “bad luck” syndrome of urban resi- dents who have few prospects or hopes of success in a commercial and extractive industrial world which they are poorly prepared to master. In a retrospective presumptive psychiatric diag. nosis of cases that I studied from 1968 to 1969 among five healers, and in 1977 with the healer don Hilde (Dobkin de Rios, 1992), from the hindsight of my subsequent training in clinieal psychology, I found the following DSM-IV diagnoses to apply to the combined sample of 31 patients: anxiety disor- der (culture-specific disorder: saladera), 32%; de- pression, 25.8%; dysthymia, 12.994 alcohoV/eocaine abuse, 9.6% marital discord, 9.65% psychosis not(COMMENTARY ON “HUMAN PHARMACOLOGY OF HOASCA 7 otherwise specified, 6.0%; posttraumatic stress dis- order, 3.0%; and biobehavioral disorders only, 3.0% A large number of patients (20/31) presented with physical disorders for the healers in addition to their psychiatric dysfunctions, Among the small sample of UDV patients studied by Grob et al. (IV = 15), a variety of pervasive dys- functional behaviors characterized the UDV mem- bers before their involvement with the sect. Clinical dysfunctions included severe to moderate alcohol use, violent behaviors, drug abuse, and other op- positional behaviors. The experimental subjects’ dis- orders contrast with the lesser psychopathology of the control group. Anxiolytic properties of the hoasca which I reported on anecdotally in 1972 may be ben- eficial to individuals such as those in Grob et al.'s study, who self-medicated with alcohol or other drugs in order to elevate their mood and feel suc- cessful and in control of their lives (see Winkelman, 1995). Unlike ayahuasca use in urban centers of the Pe- ruvian Amazon, UDV adherents follow more closely the spiritist pattem in Brazil, where membership in a religious sect is often a lifelong affair. Rituals and social activity linked to sect membership set the in- dividual apart from the larger society. Such individ- uals are constantly reinforced in their membership in a constricted group (Pressel, 1973). One could argue that the group relationship itself is an impor- tant component in the reported psychological im- provement that individuals experience as the result of their membership in the UDV. Brazil’s New Religions: A Psychiatric Perspective Since the Vargas era of the 1930s in Brazil, the traditional semifeudal rural agrarian economy has been replaced by a technologically oriented, urban industrial economy, causing dislocations and the mi- grations of large numbers of unemployed rural per- sons to urban centers searching for jobs. Urban life has weakened large extended family systems. In the midst of this sociocultural transformation, socio- psychological stress has become widespread as in- dividuals attempt to cope with new problems in their environment (Pressel, 1973). Since the 1930s, there has been a rise in new spiritist religions or sects, such as Umbanda and Candomblé, to help in- dividuals solve their personal difficulties (Brody, 1973). These syncretic religions emerged during the early period of modernization in the 1920s and have diffused to the smaller cities in the interior of Brazil as these centers became integrated into modern so- cioeconomic life. Brazil is a true “cultural mosaic” Smith, 1963) with a melting pot of ethnicities and cultures, including European Portuguese settlers, who interbred with indigenous Indian populations and later with African slaves. Additionally, new waves of immigrants from Europe, Asia, and other countries have become part of contemporary Bra- ailian life. Ina recent study of one syncretic, non-ayahuase: using religion in the northeast of Brazil, my graduate student, Sera (1993), found that in a sample of 65 clients attending Umbanda sessions, 38.6% reported DSMAILR axis I disorders, and another 27.3% re- ported symptoms that were culture-specific disor- ders, such as sorcery, underdeveloped mediumship, evil eye, and encounters with spirits of deceased an- cestors. These were locally regarded as spiritual ill- nesses. This would confirm Grob et al’s findings with regard to prior problems of the members of the UDV as well as my data from 1968 to 1977 on the major psychiatric interventions of ayahuasca heal- ers among the dysfunctional urban poor. Conclusion Grob et al’s study is unique in the application of quantitative and rigorous methodology to study a re- ligious group who have incorporated the plant hal- lucinogen ayahuasca into ritual practice over the last 35 years. While we know that such substances have a long and mostly unwritten history of use in the Amazon region of South America, such a study as the one presented for us in this Journal plays an important historic role. To my knowledge, it is the only experimental study in a natural context that enables us to make a measured judgment about out- comes and treatment efficacy. 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